Document Detail


Does poly-N-acetyl glucosamine patch use reduce arteriovenous fistula and graft failure rates in hemodialysis patients with end-stage renal disease?
MedLine Citation:
PMID:  19745608     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Maintenance of functional vascular access is crucial for the delivery of hemodialysis. The SyvekPatch is a topical marine microalgal poly-N-acetyl glucosamine hemostat approved by the Food and Drug Administration for use in the local management of bleeding wounds, such as vascular site, percutaneous catheters or tubes, and surgical debridement. METHODS: The Preservation of Vascular Access Study was designed to investigate the effectiveness of patch use in reducing failure rates of arteriovenous fistulas or grafts. Data from medical records of patients who received hemodialysis from January 2001 to December 2005 at local ambulatory outpatient hemodialysis units in Charleston, South Carolina were analyzed. To explore whether greater use of the poly-N-acetyl glucosamine patch resulted in more favorable outcomes, patients were categorized into no patch use (n = 183) or 2 groups involving patch use, <70% of hemodialysis sessions (n = 88) or >or=70% of hemodialysis sessions (n = 64). The outcome measure was failure of access site estimated using Poisson regression models. RESULTS: Three hundred thirty-five patients (54% women) with 178 fistulas (44%) and 227 grafts (56%) were included. The study population was predominantly African American (84%), with a median age of 58 years. The adjusted relative rate of access failure involving patch use in <70% of hemodialysis sessions versus no patch use was 0.84 (95% CI, 0.37-1.94), and for patch use in >or=70% of hemodialysis sessions versus no patch use was 0.40 (95% CI, 0.16-1.02; trend P = 0.045). CONCLUSIONS: The Preservation of Vascular Access Study results are consistent with improved access survival with frequent patch use. The application of patch in this population is a simple, well-accepted intervention and warrants further investigation.
Authors:
Aynur Unalp; David W Ploth; Ryan Colvin; Caroline Counts; Pamela H Shepp; Mark L Van Natta; Curtis L Meinert
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of the medical sciences     Volume:  338     ISSN:  1538-2990     ISO Abbreviation:  Am. J. Med. Sci.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-11     Completed Date:  2009-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370506     Medline TA:  Am J Med Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  178-84     Citation Subset:  AIM; IM    
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. aunalp@jhsph.edu
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MeSH Terms
Descriptor/Qualifier:
Acetylglucosamine / administration & dosage*
Female
Graft Rejection / prevention & control*
Hemostasis
Humans
Kidney Failure, Chronic / surgery*
Kidney Transplantation*
Male
Middle Aged
Renal Dialysis / methods*
Chemical
Reg. No./Substance:
0/poly-N-acetyl glucosamine; 7512-17-6/Acetylglucosamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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